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1
Stenberg, Erik. "Preventing complications in bariatric surgery." Doctoral thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-50649.
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Obesity is a major public health problem. Bariatric surgery is currently the only available treatment that offers sufficient weight-loss and metabolic benefits over time. Although bariatric surgery is considered safe now, serious complications still occur. The aim of this thesis was to identify factors associated with an increased risk for postoperative complication after laparoscopic gastric bypass surgery. Study I included patients operated with laparoscopic gastric bypass surgery in Sweden from May 2007 until September 2012. The risk for serious complication was low (3.4%). Suffering an intraoperative adverse event or conversion of the operation to open surgery were the strongest risk factors for postoperative complication. The annual operative volume and experience of the procedure at the institution were also important risk factors. Patient-specific risk factors appeared to be less important although age was associated with an increased risk. In Study II, a raised glycated haemoglobin A1c (HbA1c) was evaluated as a risk factor for serious postoperative complications in non-diabetics. A higher incidence of serious postoperative complications was seen with elevated HbA1c values, even at levels classified as ‘‘pre-diabetic’’. Study III was a multicentre, randomised clinical trial (RCT). 2507 patients planned for laparoscopic gastric bypass surgery were randomised to either mesenteric defects closure or non-closure. Closure of the mesenteric defects reduced the rate of reoperation for small bowel obstruction from 10.2% to 5.5% at 3 years after surgery. A small increase in the rate of serious postoperative complication within the first 30 days was seen with mesenteric defects closure. This relatively small increase in risk was however outweighed by the marked reduction of later reoperations for small bowel obstruction. Study IV was a comparison between study III and an observational study on the same population under the same period of time. Although the observational study reached the same conlusion as the RCT, the efficacy of mesenteric defects closure was less pronounced. Observational studies may thus be an alternative to RCTs under situations when RCTs are not feasible. The efficacy may however be underestimated.
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Bishay, M. "Understanding complications of surgery in infancy." Thesis, University College London (University of London), 2017. http://discovery.ucl.ac.uk/1575528/.
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This thesis investigates complications of surgery in infants, particularly infections and liver disease in infants receiving parenteral nutrition (PN) following gastrointestinal surgery, and intraoperative hypercapnia and acidosis in surgery for congenital diaphragmatic hernia (CDH) and oesophageal atresia with tracheo-oesophageal fistula (OA/TOF), using a series of clinical studies. A pilot randomised controlled trial comparing open versus thoracoscopic surgery in neonates with CDH and OA/TOF showed that neonatal thoracoscopy resulted in more severe intraoperative hypercapnia and acidosis than open surgery, particularly in patients with CDH. This highlights a need for studies assessing neurodevelopmental outcomes following neonatal thoracoscopy. In surgical infants receiving PN, chlorhexidine antisepsis to clean central venous catheter connectors was associated with a significant reduction in the rate of septicaemia (particularly staphylococcal). In such infants, septicaemia due to bowel organisms occurred later than septicaemia due to coagulase-negative staphylococci. In congenital duodenal obstruction, while avoidance of initial PN was successful for two thirds of cases in which it was attempted, one third subsequently required PN, and this group showed poorer growth than children who commenced PN soon after surgery. One third of surgical infants with intestinal failure develop intestinal failure associated liver disease (IFALD), and 61% developed septicaemia. I found no association between septicaemia and IFALD. In a randomised controlled trial to investigate whether glutamine supplementation affects the incidence of microbial invasion in surgical infants receiving PN, microbial invasion was detected by blood cultures, broad-range and targeted PCR for bacterial DNA, and assays of endotoxin, and lipopolysaccharide binding protein. Monocyte HLA-DR expression was measured by flow cytometry. Glutamine had no effect on microbial invasion, which was detected in 60% of patients (half of which was detected by blood culture). Glutamine supplementation significantly enhanced recovery of monocyte function. Among patients with low monocyte function at enrolment, glutamine was protective against microbial invasion.
3
Kugelberg, Maria. "Prevention of complications in pediatric cataract surgery /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-111-3/.
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Alolayan, Albraa Badr A. "Risk factors of neurosensory disturbance following bimaxillary orthognathic surgery." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hub.hku.hk/bib/B50639511.
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Objectives: To report the incidence of objective and subjective neurosensory disturbance (NSD) after orthognathic surgery in a major orthognathic centre in Hong Kong, and to investigate the risk factors that contributed to the incidence of NSD after orthognathic surgery.
Materials and Methods: A retrospective cross-sectional study on NSD after orthognathic surgery in a local major orthognathic centre. Patients who had bimaxillary orthognathic surgery reviewed at post-operative 6 months, 12 months or 24 months were recruited to undergo a neurosensory test with subjective and 3 objective assessments. Possible risk factors of NSD including subjects’ age and gender, surgical procedures and surgeons’ experience were analyzed.
Results: 238 patients with 476 sides each of maxillary and mandibular procedures were recruited. The incidences of subjective NSD after maxillary procedures were 16.2%, 13% and 9.8% at post-operative 6 months, 12 months and 24 months, respectively; the incidences of subjective NSD after mandibular procedures were 35.4%, 36.6% and 34.6% at post-operative 6 months, 12 months and 24 months, respectively. Objective neurosensory tests showed general reduced sensitivity in subjects with subjective NSD. Increased age was found to be a significant risk factor of NSD after orthognathic surgery at short term (at 6 months and 12 months) but not at 24 months. SSO has a significantly higher risk of NSD when compared to VSSO. SSO in combination with anterior mandibular surgery has a higher risk of NSD when compared to VSSO in combination with anterior mandibular surgery or anterior mandibular surgery alone. Gender of patients a nd surgeons’ experience were not found to be risk factors of NSD after orthognathic surgery.
Conclusion: The incidence of NSD after maxillary and mandibular orthognathic procedures at post-operative 6 months, 12 months and 24 months was reported. Increased age was identified as a risk factor of short term post-operative NSD but not in long term (24 months or more). Specific mandibular procedures were related to higher incidence of NSD after orthognathic surgery.<br>published_or_final_version<br>Dental Surgery<br>Master<br>Master of Dental Surgery
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Lindberg, Fredrik. "Carbon Dioxide Pneumoperitoneum - Hemodynamic Consequences and Thromboembolic Complications." Doctoral thesis, Uppsala University, Department of Surgical Sciences, 2002. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-2587.
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<p>The laparoscopic way of performing general surgical procedures was introduced all over the Western world in a few years around 1990. No previous scientific studies of the safety of this new way of performing general surgery had been undertaken.</p><p>In an animal study, it was shown that carbon dioxide pneumoperitoneum (CO<sub>2</sub>PP) causes an increase in inferior caval vein (ICV) pressure, although there were no effects on the ICV blood flow. There were gradual increases in systemic, pulmonary and ICV vascular resistance, which remained after exsufflation. These effects on vascular resistance could not be reproduced in a second animal study, presumably due to a different form of anesthesia. In this study, there was only indirect evidence of CO<sub>2</sub> PP decreasing urine output. No increase in vasopressin, which is commonly seen during CO<sub>2</sub> PP, was found, indicating that vasopressin may play a role in the decreased urine output during CO<sub>2</sub> PP but that there must be other contributing factors as well. Only brief effects on the renal arterial blood flow were seen.Renal venous pressure increased to that of the ICV.</p><p>A literature review indicated that thromboembolic complications do occur after laparoscopic cholecystectomy (LC). The relative frequencies indicated an underreporting of deep vein thrombosis (DVT) in relation to pulmonary embolism (PE).</p><p>In a clinical study, activation of the coagulation after LC was demonstrated. There were differences between the groups receiving dextran and low molecular weight heparin as prophylaxis. A further clinical study showed the incidence of DVT, as demonstrated by phlebography, to be 2.0 % (95 % confidence interval 0-6.0 %) 7-11 days after LC, even though thromboembolism prophylaxis was given in shorter courses than those scientifically proven to be effective against DVT. D-dimer values increased at the first postoperative day and even further at the time of phlebography, suggesting that the effects of LC on coagulation and/or fibrinolysis may be of longer duration than previously known.</p>
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Kelava, Marta. "HOSPITALIZATION PRIOR TO CARDIAC SURGERY AND RISK FOR POSTOPERATIVE INFECTIOUS COMPLICATIONS." Case Western Reserve University School of Graduate Studies / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=case1390513551.
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Rouvelas, Ioannis. "Esophageal cancer surgery - factors influencing survival /." Stockholm : Karolinska institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-004-6/.
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Olsson, Christian. "Thoracic Aortic Surgery : Epidemiology, Outcomes, and Prevention of Cerebral Complications." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6899.
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Shaw, P. J. "Neurological and neurophysiological complications of coronary artery bypass graft surgery." Thesis, University of Newcastle Upon Tyne, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.380746.
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Pettersson, Max. "REBUS BMI and renal surgery, perioperative outcomes and postoperative complications." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-55310.
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Bernik, N. V. "Infectious-inflammatory complications in the oral cavity after oral surgery." Thesis, БДМУ, 2021. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/19116.
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Greathouse, Kristin Cora. "Immune Function and Risk for Complications After Pediatric Cardiac Surgery." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1531406235471343.
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Kingwell, Stephen. "Predicting Complications After Spinal Surgery: Surgeons’ Aided and Unaided Predictions." Thesis, Université d'Ottawa / University of Ottawa, 2020. http://hdl.handle.net/10393/41559.
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Despite the emergence of artificial intelligence (AI) and machine learning (ML) in medicine and the resultant interest in predictive analytics in surgery, there remains a paucity of research on the actual impact of prediction models and their effect on surgeons’ risk assessment of post-surgical complications. This research evaluated how spinal surgeons predict post-surgical complications with and without additional information generated by a ML predictive model.
The study was conducted in two stages. In the preliminary stage an ML prediction model for post-surgical complications in spine surgery was developed. In the second stage, a survey instrument was developed, using patient vignettes, to determine how providing ML model support affected surgeons’ predictions of post-surgical complications.
Results show that support provided by a ML prediction model improved surgeons’ accuracy to correctly predict the presence or absence of a complication in patients undergoing spinal surgery from 49.1% to 54.8% (p=0.024).
It is clear that predicting post-surgical complications in patients undergoing spinal surgery is difficult, for models and experienced surgeons, but it is not surprising that additional information provided by the ML model prediction was beneficial overall. This is the first study in the spine surgery literature that has evaluated the impact of a ML prediction model on surgeon prediction accuracy of post-surgical complications.
14
Goggin, Michael Joseph. "Outcome and complications of photorefractive keratectomy for myopia and astigmatism /." Title page, table of contents and aims only, 2003. http://web4.library.adelaide.edu.au/theses/09MS/09msg613.pdf.
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Texler, Michael Lutz. "Aetiology of tumour cell movement during laparoscopic surgery : patterns of movement and influencing factors." Title page, table of contents and abstract only, 1999. http://web4.library.adelaide.edu.au/theses/09MD/09mdt355.pdf.
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Accompanying CD-ROM contains image files and software. Bibliography: leaves 259-286. Explores the factors affecting the movement of tumour cells from a primary malignancy across the peritoneal cavity to the port-site following laparoscopic intervention. Filter methods and radio-labelled tumour cells provided the most useful way of following cell movement. Concludes spread of tumour cells to the port-site is more likely in the presence of disseminated disease, as well as with inappropriate surgical technique. Metastasis may be reduced by the use of intraperitoneal lavage and appropriate surgical technique.
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Li, Wing-yi Vivian, and 李穎怡. "Cardiac and arterial function late after repair of aortic coarctation and interruption." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2015. http://hdl.handle.net/10722/208576.
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Although surgical and transcatheter interventions have significantly improved survival of patients with coarctation of the aorta (CoA) and interrupted aortic arch (IAA), long-term complications including left ventricular (LV) abnormalities and systemic arterial dysfunction remain issues of concern despite successful repair. While new indices of myocardial deformation that reflect diastolic and systolic function in terms of strain, strain rate, and torsion as detected by speckle tracking echocardiography have shown promise in the assessment of LV, left atrial (LA), and right ventricular (RV) mechanics, the understanding of ventricular myocardial deformation after repair of CoA is limited. In this thesis, studies were undertaken to test the hypotheses that LV, LA, and RV myocardial deformation is altered and related to structural and functional arterial alterations in adolescents and young adults late after successful intervention of CoA and IAA, and to explore the LV contractile reserve noninvasively by examining the force-frequency relationship (FFR) in these patients.
The LV, LA, and RV mechanics were evaluated with tissue Doppler and speckle tracking echocardiography, while carotid arterial structure and function were determined by radiofrequency-based echocardiographic imaging and oscillometry techniques. Supine bicycle stress exercise testing was used to evaluate the FFR by tracking the changes in LV contractility with increase in heart rate. Patients after CoA and IAA repair had significantly greater carotid arterial stiffness and intima-media thickness when compared with controls. Furthermore, mitral annular systolic and diastolic velocities, LV longitudinal and radial strain and early diastolic strain rates, peak torsion and untwisting velocity, and LA peak positive and total strain, and LA strain rates at ventricular systole, early diastole, and atrial contraction were significantly lower in patients than controls. Increased arterial stiffness and intima-media thickness was associated with worse LV myocardial deformation, while LA total strain and LA strain rate at ventricular early diastole were associated with diastolic annular velocities and strain rates. Multivariate analysis further revealed arterial stiffness as an independent determinant of LA total strain. With regard to dynamic assessment of LV contractile reserve, at submaximal exercise, the systemic blood pressures were significantly greater in patients than controls, while mitral annular systolic and early diastolic velocities remained significantly reduced. The increase in LV myocardial isovolumic acceleration, a relative load independent index of contractility, with increase in heart rate during exercise stress was significantly reduced in patients compared with controls. Flattening of FFR in patients reflected impaired LV contractile reserve, which was found to be associated negatively with increment in systemic blood pressure during exercise. For RV mechanics, patients with CoA repaired exhibited significantly lower tricuspid annular systolic and early diastolic velocities, global RV systolic longitudinal strain, and strain rate during systole, early and late diastole, compared to controls. Impairment of RV deformation was further related to increased LV mass and RV thickness. In conclusion, these findings suggest arterial dysfunction, impaired LV, RV, and LA mechanics, and reduced LV contractile reserve, in patients late after CoA and IAA repair even in the absence of residual aortic narrowing and implicate abnormal arterial-LV-LA and LV-RV interactions.<br>published_or_final_version<br>Paediatrics and Adolescent Medicine<br>Master<br>Master of Philosophy
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Brink, Abraham Justinus. "Complications of anti-reflux surgery in gastro-esophageal reflux disease with special reference to dysphagia." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/10229.
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Includes bibliographical references (leaves 40-48).<br>All patients who underwent revision laparoscopic surgery from January 202 to July 2008 in the UCT Private Academic /Groote Scruur Hospital complex for intractable dysphagia and who did not respond to consevative treatment were reviewed. Patients with peri-oesophagel fibrosis as the dominant cause for their dysphagia were identified during surgrry and closely followed up. This study was focused on those patients' pre- and post-operative course.
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Leung, Yiu-yan, and 梁耀殷. "Prevention and treatment of neurosensory disturbance after lower third molar surgery." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/208624.
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Neurosensory deficit is a well-reported complication after lower third molar surgery. It is useful to know the outcomes of the available treatments for neurosensory deficit after third molar surgery. It is more important to prevent nerve injury from third molar surgery. This thesis aims1) to evaluate the outcomes of treatments for neurosensory deficit after lower third molar surgery; 2) to investigate the effect of permanent neurosensory deficit from the patient’s perspective;3) to identify radiographic signs as predictors of inferior alveolar nerve (IAN) deficit in third molar surgery; 4)to monitor the long-term root movement and morbidities of the retained roots following coronectomy of the lower third molars.
(1) A systematic search on treatment modalities and their outcomes of neurosensory deficit after lower third molar surgery was performed. 4 surgical treatments and 2 non-surgical treatments were identified. Significant improvement in sensation was found in the majority of the subjects who received surgical or non-surgical treatment. Complete recovery was uncommon in all kinds of available treatments.
(2) Forty-eight subjects (24 cases) were recruited in a prospective case-control study comparing the general and oral health-related quality of life (QoL), life satisfaction and depression symptoms of patients with persistent lingual nerve (LN)or IAN neurosensory deficit (12 months or more) after third molar surgery with those who did not have such deficit. It was found that patients with persistent neurosensory deficit after third molar surgery have significantly poorer general and oral health-related QoL, worse life satisfaction and more depression symptoms than those without such deficits.
(3) Twelve patients with neurosensory deficit after lower third molar surgery (10 LN, 2 IAN) who received microsurgical repair of the affected nervewere recruited in a prospective longitudinal observational study of the treatmentoutcomes. Most patients with pain wererecovered after surgery. Subjective symptoms including numbness, taste sensation and speech were improved after LN repair. Improvement was noted in all three objective neurosensory tests at post-operative 12 months.
(3) Twelve patients with neurosensory deficit after lower third molar surgery (10 LN, 2 IAN) who received microsurgical repair of the affected nervewere recruited in a prospective longitudinal observational study of the treatment outcomes. Most patients with pain were recovered after surgery. Subjective symptoms including numbness, taste sensation and speech were improved after LN repair. Improvement was noted in all three objective neurosensory tests at post-operative 12 months.
(4) 178lower third molars with one or more of the five radiographic signs suggesting of close proximity of their roots to the IAN were analyzed. It was found that radiographic signs of “darkening of root(s)” and “displacement of inferior alveolar canal by the root(s)” were associated with increased risk of intraoperative IAN exposure. In addition, “darkening of the root(s)” or co-existing radiographic signs were associated with an increased risk of post-operative IAN deficit.
(5) A phase 4 clinical trial with 612 lower third molar coronectomies was conducted to monitor the long term safety of the treatment. It was demonstrated that the technique has minimal morbidity in terms of infection, pain, dry socket or development of pathologies. Most retained roots (90.9%) migrated upward with the highest migration rate in the first 6 months, which gradually slowed down and stopped to migrate at 24months. 2.3% of the roots became exposed in the oral cavity and required removal. Re-operation to remove the exposed root did not cause any IAN deficit.<br>published_or_final_version<br>Dentistry<br>Doctoral<br>Doctor of Philosophy
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Gold, Sasha Dione, and n/a. "Cognitive functioning of patients who develop delirium after cardiac surgery." University of Otago. Department of Psychology, 2006. http://adt.otago.ac.nz./public/adt-NZDU20070205.120554.
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In the present study the cognitive outcomes of cardiac surgery were examined in patients who did or did not develop delirium early post-operatively. The study expanded on previous research by investigating: (1) the relationship between delirium and functioning on specific cognitive domains; (2) the relationship between delirium and cognitive functioning after taking into account pre-existing cognitive impairment; and (3) the cognitive profile of delirium.
The study employed a non-equivalent pre-test post-test design. Participants were 80 candidates for coronary artery graft replacement and/or heart valve repair or replacement operations who were 60 years of age or over. Participants underwent a neuropsychological assessment pre-operatively, daily assessments between post-operative days 2-5 for identification of delirium, and a follow-up neuropsychological assessment 12 weeks post-operation.
Twenty-one participants met DSM-IV diagnostic criteria for delirium early post-operation. Participants who experienced delirium performed worse than participants who did not on one global cognitive measure and one specific cognitive domain at follow-up. However, this was likely due to the contribution of other factors such as age, years of schooling, pre-operative performance, and neurological events post-operation. There was no difference in the proportion of participants who did or did not develop delirium who met specified criteria for cognitive decline from pre-operation to follow-up.
Significantly more participants who developed delirium, relative to those who did not, met criteria for pre-existing cognitive impairment. After taking into account pre-existing impairment and other potentially contributing variables, delirium was a significant predictor of performance on an attentional task at follow-up.
There were no significant differences between the cognitive profiles of participants who did or did not develop delirium, at pre-operation or at follow-up. At both time points the profiles of these groups resembled the profile of a group of patients with vascular dementia.
In conclusion, although participants who experienced delirium performed worse on certain cognitive domains, this appeared to be due to factors other than delirium. However, after taking pre-existing cognitive impairment, and other relevant variables into account, delirium adversely affected attentional performance. Delirium was associated with a vascular dementia profile, but this profile was not specific to delirium.
Study findings have both theoretical and clinical implications. Consistent with the theoretical literature, the findings support impaired brain reserve as a risk factor for delirium, and the hypotheses that a combination of impaired brain reserve and events associated with delirium are responsible for subsequent cognitive performance. However, in the case of attention, events associated with delirium appear to be responsible for poorer performance, possibly due to the persistence of impaired attention, which is an essential feature of the delirium episode. A further theoretical implication is that individuals who experience delirium may be particularly vulnerable to developing vascular dementia, however, there needs to be further investigation of this risk in a non-cardiac surgery population. Clinically, study findings highlight the need to investigate possible cognitive impairment in individuals with cardiovascular disease, and in persons who experience delirium. When indicated, appropriate monitoring and/or treatment strategies should be employed to reduce the impact of cognitive deterioration.
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Mah, Michelle Clare. "Functional outcomes and long term complications following distraction osteogenesis of the maxilla and mandible: asystematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hub.hku.hk/bib/B50639626.
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Background
Distraction osteogenesis (DO) was first applied on the human craniofacial skeleton in 1992 by McCarthy et al.1 who performed lengthening of the mandible in patients with hemifacial microsomia and Nager’s syndrome. Further advances in this field have since then led to the widespread use of this modality for the treatment of numerous congenital and acquired craniofacial skeletal anomalies. In 2001, a review by Swennen et al2 concluded that up to year 1999, this form of treatment was gaining intense popularity but that the main drawbacks included insufficient data on long term results and relapse. A systematic review of the last decade on functional outcomes and long term complications following distraction osteogenesis of the facial skeleton is presented.
Methods
A structured systematic literature search, with predefined inclusion and exclusion criteria from relevant computer databases and journals were performed. The journals were evaluated and critically appraised by 2 reviewers separately in 3 rounds. Papers were categorized according to the level of evidence, the quality of methodology and the specific field of functional outcomes and long term complications. Results were then categorized according to the type of distraction movements, ie maxillary advancement and mandibular lengthening.
Results
A total of 42 papers comprising of 16 studies for maxillary advancement and 26 studies for mandibular lengthening were included in this review. Maxillary advancement was found to be beneficial in patients with cleft maxillary hypoplasia in terms of achieving aesthetic outcome but the risk for velopharyngeal insufficiency remains uncertain. The achieved maxillary advancement was stable if performed on adult patients while a recurrence of midface retrusion was noted if DO was performed on growing patients. Overcorrection was recommended in these cases to an estimated value of 20-50%. Mandibular lengthening was 99% successful in relieving respiratory obstruction in patients with isolated Pierre Robin Sequence (PRS) or syndromic micrognathic infants preventing the need for tracheostomy in the long term, and in 89% successfully decannulating infants with pre-existing tracheostomy. However, feeding and growth outcomes after airway obstruction was relieved remain unknown due to lack of sufficient evidence. Unilateral mandibular DO was successful in achieving aesthetic symmetrical facial balance in patients with hemifacial microsomia however a total loss of corrected distraction length was noted by the end of growth period if DO was performed during growth.
Conclusions
DO achieved stable results in terms of lengthening the maxilla and mandible but was also noted to cause restricted growth potential of the distracted bone. Hence, the benefits of performing DO during active growth should be weighed against the likely need for a second surgery due to a growth deficit of distracted bone and future surrounding bone growth. However DO in adults remains an alternative to conventional orthognathic surgery and choice of treatment should be patient centred.<br>published_or_final_version<br>Dental Surgery<br>Master<br>Master of Dental Surgery
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Louw, Frederik Marthinus. "Neurovascular complications in displaced extension-type supracondylar fractures in children : outcome of conservative management." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/12517.
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Includes bibliographical references<br>The aim of our study was to review our conservative management of neurovascular complications in displaced extension-type supracond ylar fractures of the humerus in children. We critically analysed the outcomes. Our results shall aim to clarify the management of this contentious issue.
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Persson, Mikael. "Wound ventilation : a new concept for prevention of complications in cardiac surgery /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-626-X/.
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Hafezi, Farhad. "Strategies for the management and prevention of complications in refractive laser surgery." [S.l.] : Rotterdam : [The Author] ; Erasmus University [Host], 2008. http://hdl.handle.net/1765/10908.
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Carreira, Marion Almeida d'Alcântara. "Short-term complications following a TPLO surgery : retrospective study of 38 cases." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2021. http://hdl.handle.net/10400.5/21862.
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Dissertação de Mestrado Integrado em Medicina Veterinária<br>ABSTRACT - Cranial cruciate ligament (CrCL) rupture is one of the most common causes of pelvic limb lameness in dogs and its etiopathogenesis is not yet completely established. Trauma can be a reason for the acute ligament injury, although the majority of cases may be the result of chronic degenerative change. Surgical treatment appears to be the preferable treatment, to minimize joint instability and progression of degenerative joint disease. Even though, intra- and extra-capsular techniques have good outcomes, tibial osteotomies are generally preferred. The tibial plateau levelling osteotomy (TPLO) aims to provide dynamic stability of the stifle joint during weight-bearing by neutralizing the cranial tibial thrust. This technique involves a radial osteotomy of the proximal tibia with subsequent rotation of the proximal segment to enable precise manipulation and reduction of the tibial plateau angle (TPA). TPLO surgery is associated with high short and long-term success rates in both small and large dogs, nevertheless intraoperative and postoperative complications can occur. In this retrospective study, the short-term complications after TPLO surgery were evaluated and risk factors that may influence its occurrence were analysed. Out of 38 TPLO surgeries, the overall complication rate was 56.2%, where 15.8% were major complications and 36.8% minor complications. Minor complications included delayed wound healing, patellar tendonitis, tibial tuberosity fracture, patellar osteophyte fracture with patellar tendonitis and iatrogenic fibular fracture. Major complications included three infections and one each of compartment syndrome/infection, implant failure/fracture and seroma with delayed wound healing. The more important major complication found was infection and delayed wound healing and patellar tendonitis were the more frequent minor complications. The only risk factor found was the size of implant which may be related to the patient’s body weight. In summary, although TPLO is associated with good to excellent outcomes, generally half of the cases may develop complications, more often minor and especially in the first 4 weeks after surgery.<br>RESUMO - COMPLICAÇÕES A CURTO PRAZO APÓS CIRURGIA TPLO: ESTUDO RETROSPECTIVO DE 38 CASOS - A rotura do ligamento cruzado cranial é uma das causas mais comuns de claudicação do membro pélvico em cães e a sua etiopatogenia não está ainda completamente conhecida. Trauma pode ser a causa para uma lesão aguda do ligamento, contudo a maioria dos casos parece resultar de alterações degenerativas crónicas no ligamento. O tratamento cirúrgico é normalmente o tratamento de eleição, para minimizar a instabilidade da articulação e a progressão da doença degenerativa articular. Apesar das técnicas intra e extra capsulares apresentarem bons resultados, as osteotomias tibiais são geralmente preferidas. A cirurgia tibial plateau levelling osteotomy (TPLO) tem como objectivo promover a estabilidade dinâmica do joelho neutralizando o avanço cranial da tibial (cranial tibial thrust). Esta técnica envolve uma osteotomia radial na tíbia proximal com subsequente rotação do segmento proximal de modo a permitir uma precisa manipulação e redução do ângulo do plateau tibial. A cirurgia TPLO está associada a uma elevada taxa de sucesso, a curto e longo prazo, tanto em cães pequenos como grandes, apesar disso complicações intra cirúrgicas e pós-cirúrgicas poderão ocorrer após esta cirurgia. Neste estudo retrospectivo, as complicações a curto prazo após a cirurgia TPLO foram avaliadas e os factores de risco que podem influenciar a sua ocorrência foram analisados. De 38 cirurgias TPLO, a taxa geral de complicações foi de 56,2%, onde 15,8% foram complicações maiores e 36,8% complicações menores. Complicações menores observadas foram atraso na cicatrização, tendinite patelar, fractura da tuberosidade tibial, fractura de osteófito patelar com tendinite patelar e fractura fíbular iatrogénica. As principais complicações maiores incluíram três infecções e uma síndrome compartimental/infecção, uma falha do implante/fractura e um seroma com atraso de cicatrização. A complicação mais importante encontrada foi infecção e atraso na cicatrização e tendinite patelar foram as complicações menores mais frequentes. O único factor de risco encontrado foi o tamanho de implante, que talvez esteja relacionado com o peso corporal do paciente.
Em resumo, embora a cirurgia TPLO esteja associada a bons e excelentes resultados, geralmente metade dos casos pode desenvolver complicações, mais frequentemente, complicações menores e especialmente nas primeiras 4 semanas após a cirurgia.<br>N/A
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Kaw, Roop, Priyanka Bhateja, y. Mar Hugo Paz, et al. "Postoperative Complications in Patients with Unrecognized Obesity Hypoventilation Syndrome Undergoing Elective Non-cardiac Surgery." American College of Chest Physicians, 2015. http://hdl.handle.net/10757/558500.
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BACKGROUND: Among patients with obstructive sleep apnea (OSA) a higher number of medical morbidities are known to be associated with those that have obesity hypoventilation syndrome (OHS) compared to OSA alone. OHS can therefore pose a higher risk of postoperative complications after elective non-cardiac surgery (NCS) and is often unrecognized at the time of surgery. The objective of this study was to retrospectively identify patients with OHS and compare their postoperative outcomes with those who have OSA alone. METHODS: Patients meeting criteria for OHS were identified within a large cohort of patients with OSA who underwent elective NCS at a major tertiary care center. We identified postoperative outcomes associated with OSA and OHS as well as the clinical determinants of OHS (BMI, AHI). Multivariable logistic or linear regression models were used for dichotomous or continuous outcomes, respectively. RESULTS: Patients with hypercapnia from definite or possible OHS, and overlap syndrome are more likely to develop postoperative respiratory failure [OR: 10.9 (95% CI 3.7-32.3), p<0.0001], postoperative heart failure (p<0.0001), prolonged intubation [OR: 5.4 (95% CI 1.9-15.7), p=0.002), postoperative ICU transfer (OR: 3.8 (95% CI 1.7-8.6), p=0.002]; longer ICU (beta coefficient: 0.86; SE: 0.32, p=0.009) and hospital length of stay (beta coefficient: 2.94; SE: 0.87, p=0.0008) when compared to patients with OSA. Among the clinical determinants of OHS, neither BMI nor AHI showed associations with any postoperative outcomes in univariable or multivariable regression. CONCLUSIONS: Better emphasis is needed on preoperative recognition of hypercapnia among patients with OSA or overlap syndrome undergoing elective NCS<br>Revisión por pares
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Lapidus, Lasse. "Thromboembolism following orthopaedic surgery : outcome and diagnostic procedures after prophylaxis in lower limb injuries /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-111-1/.
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Parkman, Sharon E. "The infant undergoing cardiac surgery : can we predict length of stay and presence of complications from age, weight, diagnoses, and type of of surgery? /." Thesis, Connect to this title online; UW restricted, 1999. http://hdl.handle.net/1773/7215.
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Hassan, Baderkhan. "Endovascular aortic aneurysm repair: Aspects of follow-up and complications." Doctoral thesis, Uppsala universitet, Kärlkirurgi, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-334369.
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Endovascular aortic aneurysm repair (EVAR) is the procedure of choice in most patients with abdominal aortic aneurysm. The drawbacks of EVAR are a higher rate of complications and frequent need for reinterventions, requiring regular postoperative follow-up. Non-stratified follow-up may have a deleterious effect on patients and the health care system. The aim of this thesis is to develop strategies that can stratify the EVAR follow-up programme according to an individual patient´s risk profile. Study I, an international multicentre study of all abdominal aortic aneurysm (AAA) patients with EVAR in three centres (2000 to 2011) demonstrated a lower rate of late complications and reinterventions in patients with sac shrinkage during the first postoperative year, compared to the non-shrinkage group. Study II, an international multicentre study of patients treated for a ruptured aortic aneurysm with EVAR in three centres (2000 to 2012) demonstrated that ruptured EVAR (rEVAR) in patients with hostile anatomy is associated with a high rate of graft-related complications, reinterventions and increased overall mortality. Study III, a two-centre cohort study of 326 patients with EVAR (2001 to 2012), with first postoperative computerised tomographic angiography (CTA) within one year of the operation. Patients with adequate proximal and distal sealing zones and no endoleak in the first postoperative CTA had significantly lower risk for AAA-related complications and reinterventions up to five years postoperatively. Study IV, studied all complications and reinterventions in a two-centre cohort study of all EVAR patients (1998 to 2012), One-fourth of the patients in the study developed complications during a mean follow-up of five years. Most complications were asymptomatic imaging-detected. Ultrasound could detect most of the clinically significant complications.
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Rizzolli, Jacqueline. "Obesidade grau III : considerações sobre complicações clínicas e tratamento cirúrgico." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2005. http://hdl.handle.net/10183/8411.
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A obesidade grau III ou também chamada obesidade mórbida é uma condição clínica freqüente e que vem apresentado crescimento progressivo, estando associada a elevadas taxas de morbi-mortalidade. Trata-se de uma doença de origem multifatorial, freqüentemente associada a comorbidezes, necessitando uma abordagem terapêutica que propicie redução de peso, melhora das doenças associadas e conseqüente melhora da qualidade de vida. O tratamento convencional deve ser sempre a primeira escolha, principalmente nos casos de inicio recente e sem antecedentes de tratamentos adequados prévios. A taxa de insucesso, contudo, é extremamente elevada, ocorrendo falha em mais de 90% dos casos. O tratamento cirúrgico atualmente é a alternativa com melhores resultados, porém com riscos de complicações a curto, médio e longo prazo, caso não seja realizado um rigoroso acompanhamento clinico, nutricional e psicológico em equipe multidisciplinar experiente. Esta revisão tem por objetivo discorrer sobre as morbidades associadas à obesidade grave, as opções de tratamento convencional e cirúrgico bem como riscos relacionados à persistência de um grande excesso de peso versus risco cirúrgico.<br>Morbid obesity is a frequent disease with a progressive increase in incidence and associated with high morbid and mortality rates. It is a multifactorial disease, and is usually associated with comorbidities. It is necessary specific treatment to reduce weight, to improve the comorbidities and obtain a better quality of life. The classic treatment, diet and exercise, should be the first choice, especially in cases of recent onset of severe obesity and poor quality previous treatments. Unfortunately, in more than 90% of the patients this kind of treatment will fail. Bariatric surgery is, nowadays, the best option of treatment, but has several risks of complications in the short, medium or long time followup, mostly in patients not followed by a specialized multidisciplinary team. This is a review about morbid obesity, comorbidities, options of treatment and the risks of stay severely obese versus surgical procedures.
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Alabbas, Haytham. "Can recent health service use predict postoperative complications in seniors undergoing colon cancer surgery?" Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=123188.
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Introduction: Colon cancer surgery is associated with high morbidity, particularly in seniors. There is currently a lack of tools for accurately assessing vulnerable patients at risk of postoperative adverse events. The aim of this study was to identify predictors of severe postoperative complications in seniors undergoing colon cancer surgery based on recent health service use data. Methods: A historical prospective cohort of colon cancer patients aged ≥ 65 years was assembled from hospitalization data provided by Quebec's provincial healthcare insurance provider (2000–2006). For each patient, health administrative claims were used to document domains of the Comprehensive Geriatric Assessment tool. 30-day postoperative severe complications were assessed using the Clavien-Dindo classification (grades III-V). A multivariate Cox model was used to evaluate associations between complications and patient characteristics. Results: 3,789 patients were included (median age: 76; female 54.3%). 24.2% of cases were emergency procedures. Postoperative complications were observed in 29% of the cohort. Grade III, IV, or V complication were experienced in 17.3%, 12.6%, and 5% of the cohort, respectively (median time to first complication: 6 days). The incidence of postoperative emergency room visits and readmissions were 17.8% and 11.3%, respectively. Multivariate analysis indicated that the following variables were significantly associated with complications: male gender (HR = 1.28, CI = 1.13-1.45), age ≥ 85 years (HR = 1.25, CI = 1.03-1.52), ≥ 10 active medications prescribed in the 6 months preceding surgery (HR = 1.24, CI = 1.03-1.49), recent care for renal insufficiency or cardiovascular disease (HR = 1.43, CI = 1.02-1.99; HR = 1.25, CI = 1.10 – 1.43), and emergency procedures (HR = 1.39, CI = 1.22-1.59). Conclusion: A large number of newly prescribed medications, recent care for renal insufficiency or cardiovascular disease, and emergency procedures were associated with severe postoperative complications. This study demonstrates the potential of developing assessment tools using recent health service use to identify vulnerable seniors at risk of postoperative complications.<br>Introduction: La chirurgie pour un cancer du colon est associée à un taux élevé de morbidité, particulièrement chez les personnes âgées. Il y a présentement un manque d'outils d'évaluation pour les patients vulnérables à risque de complications postopératoires. Le but de cette étude était d'identifier des prédicteurs de complications postopératoires graves chez les personnes âgées subissant une chirurgie pour cancer du colon, basé sur des données provenant de statistiques récentes sur l'utilisation des services de santé.Méthodes: Une cohorte prospective historique de patients atteints de cancer du colon âgés de 65 ans ou plus a été assemblée à partir de données d'hospitalisation provenant du fournisseur d'assurance de soins de santé de la province du Québec (2000-2006). Les réclamations administratives pour soins de santé de chaque patient ont été utilisées pour documenter les sections de l'Outil d'évaluation gérontologique (Comprensive Geriatric Assessment). Les complications postopératoires graves à 30 jours ont été évaluées à l'aide de la classification Clavien-Dindo (échelons III-V). Les associations entre complications et les caractéristiques des patients ont été évalués à l'aide d'un modèle Cox.Résultats: 3,789 patients ont été inclus (âge médian : 76; 54,3% féminin). 24,2% des cas étaient des chirurgies d'urgence. Des complications postopératoires ont été décelées dans 29% de la cohorte. Des complications d'échelon III, IV ou V ont été décelées dans 17.3%, 12.6% et 5% de la cohorte, respectivement (délai médian avant la première complication : 6 jours). Le taux d'incidence de visites postopératoires en salle d'urgence et de réadmission était de 17.8% et 11.3%, respectivement. Certaines variables furent associées de manière significative aux complications grâce à une analyse multivariée : sexe masculin (RR = 1.28, ICI = 1.13-1.45), âge ≥ 85 ans (RR = 1.25, IC = 1.03-1.52), plus de 10 médicaments actifs prescrits dans les 6 mois précédent la chirurgie (RR = 1.24, IC = 1.03-1.49), soins récents pour insuffisance rénale ou maladie cardiovasculaire (RR = 1.43, IC = 1.02-1.99; RR = 1.25, IC = 1.10 – 1.43), et chirurgie d'urgence (RR = 1.39, IC = 1.22-1.59).Conclusions: Une quantité importante de medicaments nouvellement prescrits, des soins récents pour insuffisance rénale ou maladies cardiovascuaires, et des chirurgies d'urgence ont tous été associés avec des complications postopératoires graves. Cette étude démontre la pertinence du développement d'outils d'évaluation basées sur des données provenant de statistiques d'utilisation des services de santé, dans le but d'identifier des populations âgées vulnérables à risque de complications postopératoires.
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Moore, Samuel William. "The study of the etiology of post-surgical obstruction in patients with Hirschsprung's disease." Thesis, University of Cape Town, 1993. http://hdl.handle.net/11427/26152.
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Myrelid, Pär. "Surgery and immuno modulation in Crohn’s disease." Doctoral thesis, Linköpings universitet, Kirurgi, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-54816.
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Crohn’s disease is a chronic inflammatory bowel disease with unknown origin. This study investigates the combined use of surgery and immuno modulation in Crohn’s disease. The outcome of medication and surgery in 371 operations on 237 patients between 1989 and 2006 were evaluated. Moreover the effects of prednisolone, azathioprine and infliximab on the healing of colo-colonic anastomosis in 84 mice with or without colitis were evaluated. The use of thiopurines after abdominal surgery in selected cases of severe Crohn’s disease was found to prolong the time to clinical relapse of the disease from 24 to 53 months. Patients on postoperative maintenance therapy with azathioprine had a decreased symptomatic load over time and needed fewer steroid courses. The use of thiopurines was found to be a risk factor of anastomotic complications in abdominal surgery for Crohn’s disease together with pre-operative intra-abdominal sepsis and colo-colonic anastomosis. The risk for anastomotic complications increased from 4 % in those without any of these risk factors to 13 % in those with any one and 24 % if two or three risk factors were present. In patients with two or more of these, or previously established, risk factors prior to surgery one should consider refraining from anastomosis or doing a proximal diverting stoma. Another possibility is to use a split stoma in which both ends of a future delayed anastomosis are brought out in the same ostomy hole of the abdominal wall. This method was found to significantly decrease the number of risk factors prior to the actual anastomosis as well as decreasing the risk of anastomotic complications, without increasing the number of operations or the time spent in hospital. In the animal model all three medications had an ameliorating effect on the colitis compared with placebo. Only prednisolone was found to interfere with the healing of the colo-colonic anastomoses with significantly decreased bursting pressure compared with placebo as well as azathioprine and infliximab. The association between azathioprine therapy and anastomotic complications may be due to a subgroup of patients with a more severe form of the disease who have an increased risk of such complications and also are more prone to receive intense pharmacological therapy.<br>Crohns sjukdom är en kronisk inflammatorisk tarmsjukdom av oklar orsak. Huvudsyftet med denna avhandling var att undersöka den kombinerade behandlingen med kirurgi och immunhämmare vid Crohns sjukdom. Utfallet av medicinsk och kirurgisk behandling vid 371 operationer på 237 patienter mellan 1989 och 2006 utvärderades. Därutöver studerades effekterna av kortison, immunhämmare och behandling med inflammationsdämpande antikroppar på läkning av tjocktarms-skarv på 84 möss med eller utan inflammation i tarmen. Vid utvalda fall med svårare form av Crohns sjukdom visade sig förebyggande behandling med immunhämmare efter kirurgi förlänga tiden till återfall av symptom från 24 till 53 månader. Patienter med immunhämmare som underhållsbehandling hade också minskade symptom under uppföljningstiden med ett minskat behov av kortison. Immunhämmande behandling inför kirurgi visade sig, liksom pågående infektion i bukhålan och sydd skarv på tjocktarmen, vara en riskfaktor för att drabbas av komplikationer vid bukkirurgi på grund av Crohns sjukdom. Risken för infektionskomplikationer i bukhålan ökade från 4 % hos dem utan någon av dessa riskfaktorer till 13 % hos dem med någon och 24 % hos dem med två eller tre riskfaktorer inför operationen. Hos patienter med två eller fler kända riskfaktorer bör man överväga att avstå från att sy en skarv på tarmen vid kirurgi eller möjligen skydda skarven med en avlastande stomi. Ett alternativ till detta är att anlägga en delad stomi där bägge ändarna av den framtida skarven tas ut genom en och samma stomiöppning i bukväggen. Denna metod med en fördröjd skarv på tarmen visade sig minska antalet kirurgiska riskfaktorer inför själva skarvningen och dessutom minska risken för tidiga infektiösa komplikationer i bukhålan, utan att vare sig öka antalet kirurgiska ingrepp eller förlänga vårdtiden på sjukhus. I en djurmodell visade sig alla tre läkemedlen ha en lindrande effekt på tarminflammation jämfört med placebo. Endast kortison visade sig påverka läkningen negativt med en sänkning av bristningstrycket i den sydda skarven på tjocktarmen, jämfört med placebo såväl som med immunhämmare och antikropps-behandling. Kopplingen mellan immunhämmare och komplikationer efter sydda skarvar på tarmen behöver alltså inte vara en direkt läkemedelseffekt. Orsaken kan istället vara att en undergrupp av Crohnpatienter har en svårare sjukdomsform som ger både ökad komplikationsrisk och större behov av intensiv medicinsk behandling.
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Viklund, Pernilla. "Quality of life after esophageal cancer surgery /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-685-9/.
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McHarg, Winsome Joy. "A study of the interrelationship between grip strength, muscle mass, metabolic utilisation of fat and surgical outcome in patients undergoing stomach and bowel surgery." Thesis, Queensland University of Technology, 1994. https://eprints.qut.edu.au/37192/1/37192_McHarg_1994.pdf.
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Numerous investigators have demonstrated a relationship between pre and postoperative hyperketonaemia and nitrogen sparing. Grip strength has recently been found to be a sensitive indicator of post-operative complications. The aims of this study were: 1) To determine whether a relationship exists between perioperative ketone status and nitrogen status and post-operative grip strength; 2) to investigate the relationship between perioperative ketone status and other factors including cancer and surgery; 3) to determine which parameters used in this study are associated with increased length of hospital stay; 4) to use the study parameters to assess the perioperative profile of patients. 64 patients undergoing gastrointestinal tract surgery were studied pre-operatively and during the post-operative week. Ketone status was assessed by plasma B hydroxybutyrate. Indicators of protein status included excretion of urea nitrogen and 3-methylhistidine, arm muscle area and thigh muscle thickness changes. Other parameters studied were weight, frame size, height, midarm circumference, triceps skinfold thickness using calipers and ultrasound, thigh fat and muscle using ultrasound, and grip strength. Nutritional intake was monitored. No significant relationship was found between ketone status and indicators of protein status or grip strength. Patients who were hyperketonaemic perioperatively (n = 9) had a significantly lower BMI than patients who were normoketonaemic perioperatively. (n = 18) (t test p = 0. 05) A significantly higher proportion of patients who were hyperketonaemic pre-operatively had triceps skinfold thickness less than the 50th percentile. (Chi Square p < 0.01 n=43) Length of hospital stay was found to correlate with percentile pre-operative grip strength in patients >69 years. (Spearman's rank order, n=15, r=0.56, p < 0.05) Post-operative grip strength (day five) less than 90% of pre-operative was also associated with increased length of stay.(17±7.3 S.D. days n=l0) Length of hospital stay for patients with post-operative grip strength > 90-100% (=23) and > 100% (n=15) of the pre-operative grip strength was 11.4±5.8 S.D. days and 10.0±2.7 S.D. days respectively. (ANOVA p= < 0.05) Thighmuscle was found to waste more than arm muscle post-operatively. (paired t test p=0.05, n=18) In contrast, no significant difference was found between postoperative arm and thigh fat wasting. A significant increase in energy intake was demonstrated between days 5 and 7 post-operatively (t test, p=0.0001) It is concluded that pre-operative grip strength is a useful indicator of length of stay in patients > 69 years. Day 5 post-operative grip strength < 90% of preoperative is associated with increased length of stay. Leg muscle wasting occurs to a greater extent than arm muscle wasting post-operatively.
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Agarwal, Aakash. "Mitigating Biomechanical Complications of Growth Rods in Juvenile Idiopathic Scoliosis." University of Toledo / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1429875994.
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Neville, Amy Anne. "The development and validation of a classification system for biliary complications following orthotopic liver transplantation." Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=121109.
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Introduction: The estimated incidence of biliary complications after OLT ranges from 10-40% but the absence of a standardized classification system prevents accurate documentation. We propose a structured classification for biliary complications following choledocho-choledochal anastomosis (CCA) at non living-related OLT. The classification is based on 3 major components and anatomic location: strictures (intrahepatic, common hepatic or anastomotic), leaks (anastomotic, non-anastomotic) and filling defects. The initial steps in proposing this classification are to test its reliability and validity. Methods: The study population consisted of OLT recipients from the McGill University Health Centre who underwent transplantation between 2004-2011. Reliability was determined using formal reliability testing including inter-rater reliability and test-retest reliability. The classification scheme was validated by analysis of the relationship between classification elements and important clinical outcomes (including diagnostic studies, need for revisional surgery, repeat transplantation, number of post-transplant hospital admissions, the total number of hospital admission days and graft and patient survival). Results: A total of 184 patients, including 76 patients with biliary complications, were included. Both inter-rater reliability and test-retest reliability showed high levels of agreement with kappa statistic greater than 0.8 for all classification elements. The proposed classification components showed a strong relationship with the selected clinical outcomes. Poorer clinical outcomes were observed with strictures when compared to leaks or filling defects. Within the differing types of strictures, increasing severity of the complications was demonstrated with higher level biliary lesions, further supporting validity of our classification method. The relationship between stricture components of the classification and days of hospital admission exemplifies the validation method; adjusted rate ratio (95% confidence interval) for days of hospital admission for anastomotic, common duct and bilateral intra-hepatic strictures was 2.01 (1.84- 2.18), 3.80 (3.42-4.21) and 7.05 (6.46- 7.70) respectively. Conclusions: The proposed classification of biliary complications shows excellent reliability and good construct validity. The significant difference in clinical outcomes between different classification components demonstrates the appropriateness of the chosen components. The classification components reflect the relative severity of the different complications, further supporting validity. Given small numbers in this preliminary study, larger numbers are needed to further validate the classification<br>Introduction: L'incidence estimée de complications biliaires après transplantation hépatique varie de 10-40%, mais l'absence d'un système de classification normalisé empêche une documentation précise. Nous proposons une classification structurée des complications biliaires après anastomose cholédocho-biliaire lors d'une greffe hépatique. La classification est basée sur trois éléments principaux et leur localisation anatomique: les sténoses (intra-hépatique, canal hépatique commun ou anastomose), les fuites (anastomose, non anastomotique) et les débris cannulaires. Les étapes initiales afin d'évaluer cette classification sont d'en mesurer la fiabilité et la validité. Méthodes: La population étudiée était composée de patients receveurs de greffe hépatique au Centre universitaire de santé McGill qui ont subi une transplantation entre 2004 et 2011. La fiabilité a été déterminée en utilisant des tests de fiabilité formelle, y compris la fiabilité « inter-évaluateurs » et la fiabilité « test-retest ». Le système de classification a été validé par l'analyse de la relation entre les éléments de classification et les résultats cliniques importants (y compris les études diagnostic, les chirurgies de révision, une re-transplantation, le nombre d'admissions à l'hôpital après la greffe, le nombre total de jours d'hospitalisation, et les durées de survie du greffon et du patient). Résultats: Un total de 184 patients, dont 76 patients présentant des complications biliaires, ont été inclus dans l'étude. La fiabilité inter-évaluateurs et la fiabilité test-retest ont montré des niveaux élevés d'accord avec valeurs de Kappa supérieures à 0,8 pour tous les éléments de la classification. Les composantes de la classification proposée ont montré une forte corrélation avec les résultats cliniques évalués. Les pires issues cliniques ont été observées plus souvent avec des sténoses qu'avec des fuites biliaires ou des débris dans le canal hépatique. En ce qui concerne la localisation des complications biliaires, une augmentation de la gravité des complications a été démontrée avec un niveau de lésion biliaire cranial, confirmant en sus la validité de la classification proposée. La relation entre les composantes des sténoses de la classification et le nombre de jours d'hospitalisation confirme la validation; les rapports de taux ajusté (intervalle de confiance à 95%) pour les jours d'hospitalisation quant à la localisation au niveau de l'anastomose, du canal hépatique commun ou en intra hépatique bilatéral: respectivement de 2,01 (1,84 à 2,18), 3,80 (3,42 à 4,21) et de 7,05 (6,46 à 7,70). Conclusions: La classification proposée des complications biliaires montre une excellente fiabilité et une très bonne validité. La différence significative entre les résultats cliniques reliés aux différentes composantes de la classification démontre la pertinence des composantes choisies. Ces composantes de la classification reflètent la gravité relative des différentes complications, ce qui soutient par surcroit la validité de la classification. Compte tenu du petit nombre de patients dans cette étude préliminaire, un plus grand nombre de patients sera nécessaire afin de valider d'avantage la classification.
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Fränneby, Ulf. "Patient-orientated aspects of the postoperative course after hernia surgery /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-810-X/.
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Carolina, Nordmark. "Inadequate antiplatelet pre-treatment in patients undergoing acute thoracic surgery. Risk for complications and cost." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-68116.
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Introduction Prior to percutaneous coronary intervention (PCI) guidelines recommend that patients with ST- elevation myocardial infarction (STEMI) receive dual antiplatelet therapy (DAPT) consisting of P2Y12 inhibition and acetylsalicylic acid (aspirin). However, in rare occasions, patients admitted with STEMI as preliminary diagnosis require acute thoracic surgery and oral P2Y12 inhibitors increases the bleeding risk over several hours. Cangrelor is an intravenous reversible P2Y12 antagonist with normal platelet function returning within 60 minutes and might therefore be an attractive alternative to oral P2Y12 inhibition.Aim Firstly, to quantify P2Y12 pre-treatment with ticagrelor in patients undergoing acute thoracic surgery and the mortality and morbidity rate associated with DAPT prior to surgery. Secondly, to estimate cost-benefit differences between cangrelor and ticagrelor pre-treatment.Material and Methods A descriptive cohort study using retrospective data. The inclusion criteria were patients undergoing acute thoracic surgery (≤ 24 hours) between January 2015 and December 2017, in the catchment area of Örebro University Hospital. Patients were stratified into groups depending on whether they had received pre-treatment with DAPT or not before surgery. Statistical analyses were made in SPSS and Excel.Results A total of 50 patients were included. 8 patients received DAPT before surgery. There was no mortality in patients receiving DAPT but TIMI major bleeding was more frequent compared to the group with no pre-treatment. The DAPT group required numerically more units of platelets and plasma, however the result was not significant. Direct treatment costs for ticagrelor was 20.14 SEK (the dosage is 2 tablets) and cangrelor was 3 059 SEK.Conclusions DAPT pre-treatment with ticagrelor was not associated with increased mortality but TIMI major bleeding was more frequent compared to the group with no pre-treatment. Direct treatment costs with cangrelor was higher compared to ticagrelor treatment. Further studies, with larger study samples, are needed to investigate complications associated with P2Y12 pre-treatment in patients undergoing acute thoracic surgery.
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Brocki, Barbara C. "Physiotherapy interventions and outcomes following lung cancer surgery." Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-45728.
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The aim of this thesis was to evaluate the effect of exercise training and inspiratory muscle training and to describe pulmonary function, respiratory muscle strength, physical performance and health-related quality of life (HRQoL) following lung cancer surgery. Study I was a randomised controlled trial including 78 patients radically operated for lung cancer. The intervention group received 10 sessions of supervised exercise training in addition to home-based exercise; the control group was instructed on home-exercise alone. Supervised compared to non-supervised exercise training did not result in differences between groups in HRQoL, except for the SF-36 bodily pain domain four months after the surgery. No effects of supervised training were found for any outcome after one year. Study II was descriptive and was based on the study I sample. We evaluated the course of recovery of HRQoL and physical performance up to one year following surgery. All patients improved HRQoL and physical performance one year after the surgery, reaching values comparable to a reference healthy population. The walked distance was positively associated with the SF-36 domain for physical functioning. Study III was descriptive, included 81 patients and evaluated the influence of surgery on respiratory muscle strength, lung function and physical performance two weeks and six months after surgery. We found that respiratory muscle strength was not affected after the second postoperative week and that muscle-sparring thoracotomy did not deteriorate respiratory muscle strength, compared to video-assisted thoracic surgery. Compared to preoperative values, physical performance was recovered, whereas lung function remained reduced six months postoperatively. Study IV was a randomised controlled trial including 68 patients at high risk of developing postoperative pulmonary complications (PPC). This study evaluated the effects of two weeks of postoperative inspiratory muscle training in addition to breathing exercises and early mobilisation on respiratory muscle strength and the incidence of PPC. Additional inspiratory muscle training did not increase respiratory muscle strength, but improved postoperative oxygenation. Respiratory muscle strength was recovered in both groups two weeks postoperatively.
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Coyne, Catherine A. "Quality of Life and Pain After Transobturator Mesh Placement." Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/623293.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.<br>Extreme controversy surrounds the uncertainty of pelvic mesh and sling devices to essentially cure patients of stress urinary incontinence (SUI). A relatively new product that has taken the market by storm is the tension free Vaginal Tape‐ Obturator (TVT‐O) mesh by Ethicon, Gynecare. It has obtained Center for Disease Control approval and labeled a “clinically proven, safe product with a 90% cure rate for urinary incontinence,” according to the manufactures website (Ethicon, Gynecare)4, 8. One side effect that is known about this particular device is its ability to leave patients post surgery with unbearable, chronic pelvic pain2. Although the mesh is needed to prevent urinary incontinence, it is pivotal that the quality of life of our patients does not suffer appreciably with elective, non‐life threatening procedures. Another common mesh product is the pelvic sling by Monarc. One‐study reports more than 95 percent of patients who underwent elective surgery with the insertion of Monarc sling achieved complete dryness and did not require the use of pads following the procedure22. These are successful outcomes, but what occurs with the minority of patients that have unfavorable outcomes such as chronic pain12, 15, 16? A retrospective study was completed to deduce the onset of pain and severity of pain caused by the TVT‐O mesh and Monarc mesh‐utilizing data from Dr. Hibner’s patients. There were 19 chronic pelvic pain patients with an average age of 50, standard deviation of 11 years, seen by Dr. Hibner and his colleagues. These patients completed the International Pelvic Pain assessment form upon their first visit to the office and SF‐36 scores of physical and mental scores were obtained. Results found physical scores of 29.5 and mental scores of 36 in pelvic pain patients, which were higher than certain other chronic, medical diseases1. We were able to conclude that patients with pelvic pain from mesh have lower physical and mental SF‐36 scores than patients with other chronic diseases representing a decreased quality of life overall.
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Amir, Nili S. "Frequency of Complications Following Spinal Fusion in Children with Cerebral Palsy." eScholarship@UMMS, 2020. https://escholarship.umassmed.edu/gsbs_diss/1070.
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Background:
Neuromuscular Scoliosis is a frequent complication of Cerebral Palsy that requires surgical management including spinal fusion. The objective of this observational study was to describe differences in the frequency of postoperative complications in children with Cerebral Palsy following spinal fusion surgery compared to children with Idiopathic Scoliosis.
Methods:
The 2016 Kids’ Inpatient Database was queried to identify pediatric patients (old) with concurrent diagnoses of Cerebral Palsy and Neuromuscular Scoliosis undergoing spinal fusion surgery. Cases were compared to children without Cerebral Palsy and with a diagnosis of Idiopathic Scoliosis undergoing the same procedure. Fitted Poisson regression analysis with robust variance was performed to estimate relative risks in the frequency of various clinical complications while adjusting for several potentially confounding variables of importance.
Results:
A total of 660 cases and 5,244 comparators were identified. Compared to children with Idiopathic Scoliosis, children with Cerebral Palsy were younger (13.6 vs. 14.3 years), more likely to be male (54% vs. 23%), and more likely to have had governmental insurance (52% vs. 32%). They also had longer hospital lengths of stay (8 days vs. 4 days). After adjusting for a number of potentially confounding sociodemographic and clinical variables, children with Cerebral Palsy were more likely to have postoperative pulmonary, gastrointestinal, and surgical complications, receive blood transfusions, and be admitted to the ICU.
Conclusions:
Children with Cerebral Palsy have an increased risk of complications following spinal fusion surgery leading to longer hospital stays. These results further inform surgical decision-making and anticipatory guidance for these children and their caregivers.
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Anvari, Mehran. "Mechanics of gastric emptying and the influence of gastric surgery /." Title page, contents and introduction only, 1995. http://web4.library.adelaide.edu.au/theses/09PH/09pha637.pdf.
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Ramanathan, Michelle L. "An investigation into the relationship between the perioperative systemic inflammatory response and postoperative complications in patients undergoing surgery for colorectal cancer." Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/6914/.
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Colorectal cancer is the second most common cause of cancer death in the western world. Despite improvements in diagnosis and treatment, 50% of patients still die from this disease. It is now recognised that postoperative infective complications contribute to poor cancer specific survival following resection for colorectal cancer. The basis of this observation is not clear. One hypothesis is that the presence of a raised systemic inflammatory response may be responsible. Whether a raised postoperative inflammatory response is the result of an early underlying infection at a preclinical stage, or whether a raised inflammatory response leads to increased susceptibility to subsequent infection is not known. If the former proves true, it is possible that targeting at risk patients with pre emptive antibiotics may reduce infective complications and improve patient outcomes. Conversely, if the latter is the case, perioperative intervention to reduce the postoperative inflammatory response may reduce infective complications and hence improve outcomes, both short and long term, for patients undergoing colorectal cancer resection. The work presented in this thesis further examines the relationship between the systemic inflammatory response and postoperative infective complications following resection for colorectal cancer, determines predictive thresholds for the development of postoperative infective complications, assesses the impact of the peak systemic inflammatory response on these thresholds and investigates the determinants of the peak response. Finally, the question as to whether a raised postoperative systemic inflammatory response is the cause or consequence of infective complications is examined.
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Parker, Trevor Wayne. "Functional outcome and complications after treatment of moderate to severe slipped upper femoral Epiphysis with a modified Dunn procedure." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5447.
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Hayes, Philip Michael. "Ethnic-specific associations between abdominal and gluteal fat distribution and the metabolic complications of obesity : implications for the use of liposuction." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/12235.
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Includes bibliographical references.<br>More than three-quarters (77%) of the 40.5 million people living in South Africa are black African, of which more than 40% are urbanised. Black African women living in urban areas have a significantly higher prevalence (62%) of overweight than urban black males (28%) or white females (53%). It was previously thought that obesity in black South African women was not associated with deleterious metabolic sequelae and was termed "healthy" obesity...
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Cálamo-Guzmán, Bernardo, and Vinatea-Serrano Luis De. "Letter to the editor in response to: The role of preoperative C-reactive protein and procalcitonin as predictors of post-pancreaticoduodenectomy infective complications: A prospective observational study." Springer International Publishing, 2018. http://hdl.handle.net/10757/622872.
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Chan, Yau-kei, and 陳佑祺. "Reducing the complications associated with emulsification in the use of polydimethylsiloxane (PDMS) based silicone oil in vitreous surgery by engineering approaches." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/196728.
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Silicone oil (SO) is widely used as the long-term intraocular tamponade in treating various eye diseases such as complicated retinal detachment, proliferative vitreoretinopathy, proliferative diabetic retinopathy, giant retinal tear and ocular trauma. However, its propensity to emulsify is an inherent problem of its long-term use in-vivo. Dispersal of SO into many tiny oil droplets causes numerous complications such as inflammation, glaucoma and reproliferation. It may also be responsible for possible toxicity to both retina and optic nerve.
Emulsification is one of the problems associated to the use of SO as a long-term intraocular tamponade. This study focused on the understanding on the physical nature and formation of in-vivo SO emulsion and the development of methods to reduce the complications associated with emulsification of SO by engineering approaches. A stepper motor driven mechanical platform was built to study the fluid flow of SO within an eye model chamber during eye-like movements and a quantitative method was established to study SO emulsification, both in-vivo and in-vitro. This method was used to compare the relative resistance of different SO against emulsification. In the last part of the thesis a novel rinse was proposed which aimed at removing the emulsified SO droplets in-vivo in an effective way.
In the dynamic eye model experiment, both the increase in shear viscosity of SO and the extent of SO fill had an effect in reducing the shear. These effects were small compared to the effect of indents at reducing shear rate during eye-like movements.
When SO emulsions from patients were analyzed it was found that over 90% of the emulsified droplets were outside the observable range under slit-lamp biomicroscopy.
When the emulsification resistance of SO was tested using the quantitative method the result confirmed that SO with high-molecular-weight component (HMWC) was more emulsification resistant than SO with the same shear viscosity. The addition of HMWC increases the elasticity and thus increasing its resistance against emulsification.
A novel rinse was also proposed to remove the emulsified droplets using physical phenomenon of double emulsification.
To conclude, this study improved the understanding of the formation of SO emulsification. The clinical observable emulsified droplets are probably in all cases that was just the tip of the iceberg. Three practical suggestions were made: Firstly, the use of SO and encircling scleral buckling procedure in combination might reduce the shear rate. Secondly, the use of HMWC can reduce emulsification. Lastly, there may be a role in rinsing out the emulsified droplets using the proposed novel solution. The novel solution is going to fully developed and commercialized in the near future.<br>published_or_final_version<br>Ophthalmology<br>Doctoral<br>Doctor of Philosophy
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Ahlgren, Ewa. "Cerebral complications after cardiac surgery : a clinical study with special reference to cognitive function and driving performance /." Linköping : Univ, 2002. http://www.bibl.liu.se/liupubl/disp/disp2002/med736s.pdf.
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Lahtinen, S. (Sanna). "Complications, quality of life and outcome after free flap surgery for cancer of the head and neck." Doctoral thesis, Oulun yliopisto, 2019. http://urn.fi/urn:isbn:9789526221823.
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Abstract Free flap surgery (FFS) is used for the reconstruction of head and neck defects after tumor resection. Compared to many other cancers requiring operative care, postoperative complications are frequent and the long-term outcome is poor in this patient group. The impact of postoperative complications on outcome, quality of life (QOL) and causes of death has not been well studied. The aim of this thesis was to study the factors associated with postoperative complications after FFS for cancer of the head and neck, as well as the impact of complications on QOL and long-term outcomes. The thesis includes one prospective and three retrospective studies. The study population was 146 head and neck patients undergoing FFS in Oulu University Hospital from 2008 to 2016. The impact of goal-directed fluid management using SVV (stroke volume variation) analysis on postoperative outcome was evaluated retrospectively. It led to a significant reduction in intraoperative fluid administration (6070 ml vs. 8185 ml) and length of stay (LOS) in hospital (11.5 vs. 14.0 days) but had no impact on the rate of postoperative complications. Postoperative complications were recorded in 60% of the patients and were related to alcohol abuse, complicated intraoperative course and fibular flap surgery. The patients with late complications (occurring after the fourth postoperative day) had higher mortality compared to those without. The QOL of 53 patients undergoing operations during 2013-2016 was evaluated using four questionnaires. Patients with medical complications (n=12, 22.6%) had significantly lower QOL in most domains of RAND-36 but QOL for those without complications was comparable to the general population. A total of 62/146 patients (42.5%) died by the end of 2016, and in 72.6% of cases the cause of death was the primary disease. In multivariate analysis male gender, low BMI, ASA above 2 and late medical complications were indicative for long-term mortality. In conclusion, postoperative complications have an impact on outcome after FFS for cancer of the head and neck in terms of QOL and long-term mortality. Patient-related factors were associated with unfavorable outcomes when intraoperative factors did not have as significant a role. Prevention of medical complications and adequate patient selection are essential when aiming to improve outcome after FFS<br>Tiivistelmä Mikrovaskulaarikielekkeitä käytetään korjaamaan kasvaimen poiston vuoksi syntyneitä kudospuutoksia pään ja kaulan alueen syöpäpotilailla. Näihin toimenpiteisiin liittyy merkittävä komplikaatioriski ja myös itse syövän pitkäaikaisennuste on huono. Komplikaatioiden vaikutusta toipumisvaiheen elämänlaatuun ja kuolleisuuteen ei ole tutkittu. Tämän väitöskirjatyön tavoitteena oli selvittää tekijöitä, jotka liittyvät leikkauksen jälkeisiin komplikaatioihin, ja niiden merkitystä potilaiden elämänlaatuun ja pitkäaikaisennusteeseen. Tutkimuskokonaisuus koostuu kolmesta retrospektiivisestä tutkimuksesta ja yhdestä prospektiivisesta haastattelututkimuksesta. Tutkimukseen kuului 146 vuosina 2008–2016 Oulun yliopistollisessa sairaalassa leikattua pään ja kaulan alueen syöpäpotilasta. Tutkimuksessa selvitettiin tavoiteohjatun nestehoidon vaikutusta välittömään toipumisvaiheeseen, mutta tällä ei todettu olevan vaikutusta komplikaatioiden ilmaantumiseen. Sen sijaan potilaiden saama nestemäärä väheni merkitsevästi (6070 ml vs. 8185 ml) ja sairaalahoitojakson pituus lyheni (11,5 päivää vs. 14 päivää). Komplikaatioita todettiin 60 % leikkauksista ja useimmin komplikaation sai potilas, jolla oli alkoholin liikakäyttöä, ongelmia toimenpiteen aikana ja luullinen siirre. Neljännen leikkauksen jälkeisen päivän jälkeen ilmenneisiin komplikaatioihin liittyi korkeampi pitkäaikaiskuolleisuus. Elämänlaatu arvioitiin 53 potilaalta, jotka oli leikattu vuosina 2013–2016. Ei-kirurgisia komplikaatioita esiintyi 12 potilaalla ja heidän raportoimansa elämänlaatu oli merkitsevästi alentunut verrattuna muihin potilaisiin. Ilman komplikaatioita toipuneiden elämänlaatu oli verrattavissa väestöarvoihin. 42,5 % leikatuista potilaista oli kuollut vuoden 2016 loppuun mennessä ja 72,6 % heistä kuolema johtui hoidetusta syövästä. Monimuuttujamallissa pitkäaikaiskuolleisuuden riskitekijöitä olivat miessukupuoli, matala BMI, ASA-luokka yli 2 sekä todetut ei-kirurgiset komplikaatiot. Yhteenvetona voidaan todeta, että komplikaatioilla on merkitystä toipumisvaiheen elämänlaatuun ja pitkäaikaiskuolleisuuteen tässä potilasryhmässä. Potilaslähtöiset tekijät vaikuttavat merkittävästi komplikaatioiden ilmaantumiseen ja myös huonoon ennusteeseen. Ei-kirurgisten komplikaatioiden estäminen kuten myös oikea potilasvalinta ovat keskeisessä asemassa, kun tämän potilasryhmän hoidon tuloksia halutaan parantaa
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Tran, Diem. "Clinical Prediction Rule for the Development of New Onset Postoperative Atrial Fibrillation After Cardiac Surgery." Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/24400.
Full textAbstract:
This project set out to derive a prediction rule based on preoperative clinical variables to identify patients with high risk of developing atrial fibrillation following cardiac surgery. Methods: Prospectively collected data from a perioperative database was corroborated with chart review to identify eligible patients who had non-emergent surgery in 2010. Details on 28 preoperative variables were collected and significant predictors (p<0.2) were inserted into multivariable logistic regression and recursive partitioning. Results: 305 (30.5%) of 999 patients developed new onset postoperative atrial fibrillation. Eleven variables were significantly associated with atrial fibrillation, however, both final models included only three: left atrial dilatation, mitral valve disease and age. Bootstrapping with 5000 samples confirmed that both final models provide consistent predictions. Coefficients from the logistic regression model were converted into a simple seven point predictive score. Conclusions: This simple risk score can identify patients at higher risk of developing atrial fibrillation after cardiac surgery.